碳青霉烯耐药肠杆菌科细菌感染脓毒症患者的危险因素和耐药性  

Analysis of risk factors and drug resistance of carbapenem-resistant enterobacteria in patients with sepsis

作　　者：史静[1] 陈晴毅 徐绣宇[1] 严立[1] 孙珊[1] 夏云[1] 梁涛 牛司强[1] SHI Jing;CHEN Qing-yi;XU Xiu-yu;YAN Li;SUN Shan;XIA Yun;LIANG Tao;NIU Si-qiang(The First Affiliated Hosbital of Chongging Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院检验科,重庆400016

出　　处：《中华医院感染学杂志》2022年第23期3547-3551,共5页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划基金资助项目(2017YFC0909902);重庆市自然科学基金面上项目(cstc2019jcyj-msxmX0349)。

摘　　要：目的研究碳青霉烯耐药肠杆菌科细菌(CRE)感染脓毒症患者的危险因素和耐药性,为有效控制CRE感染的脓毒血症提供依据。方法对医院2015-2020年CRE感染的脓毒症患者基本信息、病因诊断、主要检验结果、用药和处理情况等流行病学资料进行回顾性分析,同时选取该院CRE感染的非脓毒症患者作为对照组,探讨CRE感染的脓毒症危险因素。结果收集到172例CER感染的脓毒血症和110例CRE感染的非脓毒血症病例,单因素分析结果显示,两组呼吸系统疾病、心血管系统疾病、周围血管疾病、中性粒细胞减少、重症贫血、检出前使用四代头孢菌素、碳青霉烯类、糖肽类、抗真菌类抗菌药物、ICU天数、胃管留置天数、静脉置管天数、动脉置管天数、机械通气天数等比较有统计学差异(P<0.05)。多项Logistic回归分析结果,心血管疾病、周围血管疾病、血液系统疾病、机械通气天数和检出前使用碳青霉烯类与抗真菌类抗菌药物为CRE感染的脓毒症患者的独立危险因素(P<0.05)。CRE感染脓毒症患者的分离菌株对临床常用抗菌药物耐药率均>50%。结论CRE感染的脓毒症具有多个危险因素,并且CRE感染的脓毒症患者对临床常用抗菌药物有较高的耐药性,加强对这些危险因素的控制可有效预防CRE感染的脓毒症发生。OBJECTIVE To study the risk factors and drug resistance of carbapenem-resistant Enterobacteriaceae(CRE)infection in patients with sepsis,and to provide timely and accurate anti-infective treatment for patients with clinical CRE infection.METHODS The epidemiological data of sepsis patients with CRE infection in the First Affiliated Hospital of Chongqing Medical University from 2015 to 2020 were enrolled in the group and retrospectively analyzed.And patients with non-sepsis infected with CRE in this hospital were divided in the control group.The risk factors for sepsis infected with CRE was explored.RESULTS Total of 172 cases of CER-infected sepsis and 110 cases of CRE-infected non-sepsis were collected.Univariate analysis showed that there were significant differences in respiratory diseases,cardiovascular diseases,peripheral vascular diseases,neutropenia,severe anemia,use of fourth-generation cephalosporins,carbapenems,glycopeptides,antifungal antibiotics before detection,ICU days,gastric tube indwelling days,venous catheterization days,arterial catheterization days and mechanical ventilation days between the two groups(P<0.05).According to multivariate Logistic regression analysis,cardiovascular disease,peripheral vascular disease and mechanical ventilation days are independent risk factors for sepsis infected with CRE.The drug resistance rates of strains isolated from sepsis patients infected with CRE to commonly used antibiotics were>50%.CONCLUSION CRE-infected sepsis has many risk factors,and patients with CRE-infected sepsis are highly resistant to clinically used antibiotics.Strengthening the control of these risk factors and drug resistance testing can effectively prevent sepsis of CRE infection.

关 键 词：脓毒症 碳青霉烯类耐药肠杆菌科细菌 耐药性 危险因素 抗菌药物 

分 类 号：R459.7[医药卫生—急诊医学]